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Background and purpose <p>Between 5% and 20% of patients with breast cancer (BC) experience locoregional recurrence (LRR). Managing LRR in previously irradiated areas is particularly challenging. We evaluated the toxicity and efficacy of stereotactic body re-irradiation in this context.</p> Materials and methods <p>This was a single-center retrospective study conducted between January 2009 and December 2022. It included patients who underwent stereotactic re-irradiation for LRR of BC. We assessed toxicity, local control (LC), progression-free survival (PFS), and overall survival (OS).</p> Results <p>Eighteen patients were included. The median dose of the initial radiotherapy (RT) was 60&#xa0;Gy (range: 50–68&#xa0;Gy). Recurrences occurred in level I-II nodes (<i>n</i> = 10), internal mammary nodes (IMN; <i>n</i> = 4), level III (<i>n</i> = 2), and level IV (<i>n</i> = 2). The median interval between the two irradiations was 11 years (range: 1–24 years). The most commonly used stereotactic re-irradiation regimens were 6 × 6&#xa0;Gy and 3 × 9&#xa0;Gy. Median D50% to the GTV and PTV was 36.9&#xa0;Gy (32–41.8&#xa0;Gy) and 35.7 (30.2–40.6&#xa0;Gy), respectively. The D0.035&#xa0;cc to the brachial plexus was 11.2&#xa0;Gy (range, 4–33.6&#xa0;Gy). With a median follow-up of 4.5 years from the start of SRT (IQR: 2.0‒7.5), no radiation-induced brachial plexopathy was observed. The cumulative incidence of locoregional recurrence was 56.4% (95%CI: 30.8–75.6) at 2 years. The 5-year overall survival (OS) rate was 75.5% (95CI: 39.7–91.8), with most deaths attributed to distant metastases.</p> Conclusion <p>Stereotactic re-irradiation is a well-tolerated treatment option for LRR in breast cancer. Particular care should be taken to minimize the dose to the brachial plexus. While local control is acceptable, the risk of further regional recurrence remains high.</p>

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Stereotactic re-irradiation for lymph node recurrence of breast cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月8日

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  • Zied Fessi,
  • Salomé Bonnier,
  • Kaoutar Lodyga,
  • Jennifer Wallet,
  • Maël Barthoulot,
  • Chloé Delerue,
  • Pauline Lemoine,
  • Paul Archer,
  • Marie Dworczak,
  • David Pasquier

摘要

Background and purpose

Between 5% and 20% of patients with breast cancer (BC) experience locoregional recurrence (LRR). Managing LRR in previously irradiated areas is particularly challenging. We evaluated the toxicity and efficacy of stereotactic body re-irradiation in this context.

Materials and methods

This was a single-center retrospective study conducted between January 2009 and December 2022. It included patients who underwent stereotactic re-irradiation for LRR of BC. We assessed toxicity, local control (LC), progression-free survival (PFS), and overall survival (OS).

Results

Eighteen patients were included. The median dose of the initial radiotherapy (RT) was 60 Gy (range: 50–68 Gy). Recurrences occurred in level I-II nodes (n = 10), internal mammary nodes (IMN; n = 4), level III (n = 2), and level IV (n = 2). The median interval between the two irradiations was 11 years (range: 1–24 years). The most commonly used stereotactic re-irradiation regimens were 6 × 6 Gy and 3 × 9 Gy. Median D50% to the GTV and PTV was 36.9 Gy (32–41.8 Gy) and 35.7 (30.2–40.6 Gy), respectively. The D0.035 cc to the brachial plexus was 11.2 Gy (range, 4–33.6 Gy). With a median follow-up of 4.5 years from the start of SRT (IQR: 2.0‒7.5), no radiation-induced brachial plexopathy was observed. The cumulative incidence of locoregional recurrence was 56.4% (95%CI: 30.8–75.6) at 2 years. The 5-year overall survival (OS) rate was 75.5% (95CI: 39.7–91.8), with most deaths attributed to distant metastases.

Conclusion

Stereotactic re-irradiation is a well-tolerated treatment option for LRR in breast cancer. Particular care should be taken to minimize the dose to the brachial plexus. While local control is acceptable, the risk of further regional recurrence remains high.